February 15, 2012

Some compliance officers half wish for a Medicare audit or corporate integrity agreement at their organizations because they know it will give them the resources and leverage to get a challenging job done.

There are frustrations with work overload and lukewarm support from senior leaders at some organizations, although other compliance officers say they face no significant hurdles and have the tools they need.

There is consensus, however, that the job is getting harder.

"This is my 14th year in this role and I don't think I have ever seen it as intense as it is today," says Jackson Ellison, vice president of compliance and chief privacy officer for Presbyterian Healthcare Services in Albuquerque.

"To use an old military term, it feels like our position has been overrun.

I try to stay balanced and even, but people are overwhelmed trying to do their day-to-day work.

There are not enough people in compliance and operations to really respond to all these things," including medical-record requests from auditors.

The size of his compliance team --- seven people --- has remained the same at Presbyterian, an integrated delivery system with hospitals, clinics, a health plan and other entities.

Compliance officers say they are doing more work than ever and their stress levels are intensifying, developments that have come into focus in recent Health Care Compliance Assn.

"The picture of compliance is a bright one," HCCA reported in its latest survey, noting that 52% of compliance officers surveyed said they are not concerned about losing their jobs, and 38% enjoyed budget increases last year.

In a January HCCA survey, 58% of compliance officers said "they often wake up during the middle of the night worrying about job-related stress and 60% report having considered leaving their positions in the last 12 months due to job-related stress."

One challenge in the compliance world is drawing the line between compliance and operations.

"There is this all over fuzziness where compliance's role begins and ends," says Ami Zumkhawala-Cook, chief compliance officer at Holy Spirit Hospital in Camp Hill, Pa.

It's somewhat inevitable; compliance has to immerse itself in departments to help them interpret regulations, solve problems and respond to audits, among other things.

The lack of clarity about whose job compliance is causes great stress for compliance officers, says Margaret Hambleton, senior vice president for ministry integrity at Saint Joseph Health System in Orange, Calif.

For example, Holy Spirit's audit coordinator took a position on a billing practice, backed by information from a webinar and from coding resources.

"Despite that, management is still considering hiring an outside consultant because they feel the audience will listen more trustingly."

"There is a lack of understanding of the role of compliance officers and compliance programs" among executives and board members, he says.

"No one listens to me here," says a compliance officer, who asked not to be identified.

She is caught between the CEO, who hired her, and the CFO, who resents when compliance activities reduce hospital revenue.

The compliance officer has confirmed this with her own surveys and reported the problem to management, which was shocked by the findings.

For hospitals like hers, things may not change "unless there's a big audit" or enforcement action, the compliance officer says.

In stark contrast to her experience, Mic Sager, compliance officer for Olympic Medical Center in Port Angeles, Wash., says he feels more effective as time marches on --- and he attributes it to the fact that "I kind of wiggled myself into" the inner workings of the top executives.

Every Wednesday, the C-suite meets, and Sager attends one meeting per month.

Even so, Ellison is worried that senior leaders will take their eye off the compliance ball as they cope with financial pressures and reconfigure business models.

The more compliance is baked into your culture, Ellison says, the better your organization can fend off threats from problematic business plans.

But he isn't taking chances; Ellison will make sure executives don't brush off regulatory requirements and ethical standards.